DESCRIPTION: This randomized clinical trial examines the benefit of adding an active health promotion component to basic primary care services for severely mentally ill adults (SMI). Study outcomes are health status, self-efficacy, quality of life, and medical and psychiatric service utilization. The target population is medically vulnerable due to lifestyle and environmental risk factors associated with severe psychiatric illness, as well as sequelae of long-term pharmaco-therapy. Despite ample documentation of their excess medical morbidity and mortality, few studies have addressed non-psychiatric health problems of the SMI or tested models to engage them in their own care. This is a serious omission given the impact of poor health on quality of life and service utilization. In this trial, subjects will be recruited in short-term residential programs where nurse practitioners currently provide basic primary care services (BPC), including screening, immediate care, and referrals as needed. BPC provides the usual care condition for this study. 195 subjects will be enrolled and randomly assigned to BPC or to BPC plus Wellness Training (BPC plus WT), a 12-month health promotion model that develops individualized skills in self-assessment, self-monitoring and management of illness. This intervention extends established methods for psychiatric symptom management to general health problems and concerns. During the residential care episode, all subjects will receive thorough health evaluations and will complete baseline interviews measuring variables that may influence study outcomes, including age, gender, ethnicity, conjugal status, housing situation, substance use, adherence to psychiatric medication, psychiatric diagnosis and functional level. After discharge to the community, all subjects will continue to have access to BPC nurse practitioners for advice and referrals. In addition, subjects in the intervention group will receive 12 months of individualized wellness training. Follow-up interviews with all subjects will measure study outcomes (health status, self-efficacy, quality of life, and medical and psychiatric service utilization) at 6, 12, and 18 months. This study will recruit and retain sufficient numbers of subjects to detect the impact of the intervention while controlling for important covariates that influence health-related outcomes. Findings will contribute substantially to knowledge about active and individualized health promotion for the SMI and its value above and beyond that of basic primary care.